While the staffing crisis facing the NHS has been well-documented, the mechanics behind how Trusts secure skills, and how this contributes
to the problem is rarely discussed. The fact is that NHS
Trusts are frittering away millions of pounds each year through inefficient,
disjointed staffing strategies, and small tweaks in terms of organisational
structure could have a significant influence on the way that workforces are
recruited and managed. This would have a huge impact on not only staffing
spend, but also employee engagement, continuity of care and patient outcomes.
Unfortunately, most trusts are set up in a way which facilitates this
wasteful approach. Trusts are typically structured so that permanent
recruitment managers sit separately from temporary staffing teams. While the
latter has full autonomy to utilise agencies to plug gaps, the former often has
no authority or budget to work with external recruitment partners – meaning
vacancies are regularly left unfilled – and have to be covered by temps.
This leads to huge amounts of spending on temporary agency fees. Recently, I
met with a large Trust in the East of England which had six permanent Community
nursing vacancies open in one particular service – we had the people to fill
them, but the hiring manager didn’t have the capability to work with us. This led
to the vacancies being plugged by long term agency workers which were managed
by a different department, at a cost increase to the trust compared to hiring
the staff permanently through an agency. The nonsensical approach of separating
the two departments and preventing them from sharing resources was the key
factor preventing the vacancies from being filled.
The true extent of this wastefulness cannot be
underestimated. To get a rough picture of just how much the NHS are spending on
temporary staff, we can do the following analysis.
By taking the agency fees incurred when bringing on board a single Band 5
agency nurse, which typically sit at around £152 a week, and calculating this
over 12 months, we reach costs of almost £8000: enough to pay a permanent
introduction fee four times over. If you extrapolate this figure to take
into account the 37,917 advertised full-time equivalent nursing and midwife
posts which were open at NHS Digital’s last count, the health service would be splurging in excess of £300,000,000
on agency fees when there is permanent talent available to fill the vacancies.
Luckily, there are straightforward methods which the NHS can
implement to bring spending down. Firstly, it’s crucial that permanent
recruitment and temporary staffing teams become fully integrated, working to
the same budget and strategic objectives. Reducing the amount of temporary
staff on their books should be of paramount importance for both. For those who bring up the objection that
hiring permanent staff would see increases to their payroll, along with pension
costs and other employee benefits, these still pale in comparison to the cost
of employing agency staff year-round. For instance, hiring a permanent Band 5
nurse with pension costs included still comes to £16,488 less than what an
agency worker would cost. This ties into a wider need for
more strategic workforce planning. Advanced workforce management,
utilised in many private industries, will help the NHS deploy workforces more
effectively in the short term, and also pipeline talent for the future. By
allowing strategists in on daily operations, areas which need immediate
attention can be examined and taken care of. Other
approaches, such as strengthening employee brand will also improve retention. With research showing that 63%
of employees admit a trusted employer increases job satisfaction, this is
something that shouldn’t be ignored.
Change is possible
Ultimately, with concerted effort across the board, small adjustments could make a huge amount of difference in reducing levels of agency spend, improving care, and saving lives. Through relatively simple methods, decision makers can ensure long-lasting impact.